Medical Treatment in the Case of Severe Coronary Artery Disease

  • O. Oldenburg
  • R. Erbel
Conference paper

Abstract

In Europe, every year up to 63,500 patients undergo coronary bypass surgery and more than 147,700 patients percutaneous transluminal coronary angioplasty (PTCA) [1]. Additionally, the thrombolytic therapy of acute myocardial infarction results in an increasing number of patients surviving coronary artery disease (CAD) with and without heart failure. Repeated coronary interventions and coronary bypass surgerys are common. The treatment of these patients imposes special demands on the physician. In the following we describe the medical therapy of patients with advanced CAD with and without heart failure.

Keywords

Cholesterol Nicotine Digoxin Fibrinogen Verapamil 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Röthlisberger C, Meier B (1995) Coronary interventions in Europe 1992. Eur Heart J 16:922–929PubMedGoogle Scholar
  2. 2.
    Rudolph W, Dirschinger J (1991) Clinical comparison of nitrates and sydnonimines. Eur Heart J 12 (Suppl E):33–41PubMedGoogle Scholar
  3. 3.
    Große-Heitmeyer W (1994) Modsidomin intravenös bei Herz-Kreislauf-Erkrankungen - Zusammenfassende Übersicht. Med Klinik 89:62–63Google Scholar
  4. 4.
    Bassenge E, Personal communicationGoogle Scholar
  5. 5.
    Münzel T, Bassenge E (1993) Chronic angiotensin converting enzyme-inhibition retards nitrate tolerance and prevents coronary rebound constriction (Abstract). Circulation 88:1–90Google Scholar
  6. 6.
    Boesgaard S, Iversen HK, Wroblewski H et al. (1994) Altered peripheral vasodilator profile of nitroglycerin during long-term infusion of N-acetylcystein. J Am Coll Cardiol 23:163–169PubMedCrossRefGoogle Scholar
  7. 7.
    Sawicki PT, Berger M (1992) Metabolische Wirkungen von β-Rezeptorenblockern. Dtsch med Wschr 117:875–879PubMedGoogle Scholar
  8. 8.
    Leschke M, Strauer BE (1995) Wie selektiv sind kardioselektive β-Rezeptorenblockern. Dtsch med Wschr 120:45–46PubMedGoogle Scholar
  9. 9.
    Dargie HJ (1996) Angina and left ventricular dysfunction. Eur Heart J 17 (Suppl G):2–7PubMedGoogle Scholar
  10. 10.
    Ritter MM, Richter WO (1995) Gesundheitliche Auswirkungen einer vegetarischen Lebensweise. Fortschr Med 113:239–242PubMedGoogle Scholar
  11. 11.
    Watts GF, Lewis B, Jackson P et al (1995) Relationships between nutrient intake and progression/regression of coronary atherosclerosis as assessed by serial quantitative angiography. Can J Cardiol 11 (Suppl G):110G–114GPubMedGoogle Scholar
  12. 12.
    The Scandinavian Simvastatin Survival Study Group (1994) Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4 S); Lancet 344:1383–1389Google Scholar
  13. 13.
    Shepherd J, Cobbe SM, Ford I et al. (1995) Prevention of coronary heart disease with pravastatin in men with hypercholesterinemia. N Engl J Med 333:1301–1307PubMedCrossRefGoogle Scholar
  14. 14.
    Sacks FM, Pfeffer MA, Moye LA et al. (1996) The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 335:1001–1009PubMedCrossRefGoogle Scholar
  15. 15.
    Law MR, Wald NJ, Thompson SG (1994) By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ 308:367–372PubMedCrossRefGoogle Scholar
  16. 16.
    Nawrocki JW, Weiss SR, Davidson MH et al (1995) Reduction of LDL cholesterol by 25% to 60% in patients with primary hypercholesterinemia by atorvastatin, a new HMG-CoA reductase inhibitor. Arterioscler Thromb Vase Biol 15:678–682CrossRefGoogle Scholar
  17. 17.
    Zeiher AM, Drexler H, Wollschläger H, Just H (1991) Modulation of coronary vasomotor tone in humans, progressive endothelial dysfunction with different early stages of coronary atherosclerosis. Circulation 83:391–401PubMedGoogle Scholar
  18. 18.
    Vogel RA, Corretti MC, Plotnick GD (1996) Changes in flow-mediated brachial artery vasoactivity with lowering of desirable cholesterol levels in healthy middle-aged men. Am J Cardiol 77:37–40PubMedCrossRefGoogle Scholar
  19. 19.
    Stroes ESG, Rabelink TJ (1997) Hyperlipidemia and endothelial function; in: Born GVR, Schwartz CJ. Vascular endothelium, Schattauer, Stuttgart, pp 311–328Google Scholar
  20. 20.
    Kobashigawa JA, Katznelson S, Laks H et al (1995) Effects of pravastatin on outcomes after cardiac transplantation. New Engl J Med 333:621–627PubMedCrossRefGoogle Scholar
  21. 21.
    The post coronary artery bypass graft trial investigators (1997). The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary artery bypass grafts. N Engl J Med 336:153–163CrossRefGoogle Scholar
  22. 22.
    Despres JP, Lamarche B, Mauriege P et al (1996) Risk factors for ischaemic heart disease: is it time to measure insulin? Eur Heart J 17:1453–1454PubMedGoogle Scholar
  23. 23.
    Wilson PWF (1994) Established risk factors and coronary artery disease: The framingham study. Am J Hypertens 7:7S–12SPubMedGoogle Scholar
  24. 24.
    de Faire U, Ericsson CG, Grip L et al. (1996) Secondary preventive potential of lipidlowering drugs. The bezafibrate coronary atherosclerosis intervention trial (BECAIT). Eur Heart J 17 (Suppl F):37–42PubMedGoogle Scholar
  25. 25.
    de Faire U, Ericsson CG, Grip L et al. (1997) Retardation of coronary atherosclerosis: the bezafibrate coronary atherosclerosis intervention trial (BECAIT) and other angiographic trials. Cardiovasc Drugs Ther 11 (Suppl 1):257–263PubMedCrossRefGoogle Scholar
  26. 26.
    Leschke M, Höffken H, Vogt M et al. (1989) Intermittent urokinase therapy as a new strategy concept in untracable angina pectoris (Abstract). J Am Coll Cardiol 13:16AGoogle Scholar
  27. 27.
    Leschke M, Schoebel FC, Mecklenbeck W, Strauer BE (1993) Intermittent urokinase therapy in symptomatic end-stage coronary artery disease (Abstract). J Am Coll Cardiol 21:452AGoogle Scholar
  28. 28.
    Schoebel FC, Leschke M, Stein D et al. (1995) Chronic-intermittent urokinase therapy in refractory angina pectoris. Fibrinolysis 9 (Suppl 1): 121–125CrossRefGoogle Scholar
  29. 29.
    Schoebel FC, Leschke M, Strauer BE (1995) Therapierefraktäre Angina pectoris. Pathophysiologische Grundlagen und alternative Therapieansätze. Dtsch med Wschr 120:301–307PubMedCrossRefGoogle Scholar
  30. 30.
    Schreiner PJ, Morrisett JD, Sharret AR et al (1993) Lipoprotein (a) as a risk factor for preclinical atherosclerosis. Arterioscler Thromb 13:826–833PubMedCrossRefGoogle Scholar
  31. 31.
    Haffner SM, Gruber KK, Aldrete G et al (1992) Increased lipoprotein (a) concentrations in chronic renal failure. J Am Soc Nephrol 3:1156–1162PubMedGoogle Scholar
  32. 32.
    Thiery J, Seidel D (1992) Neue Strategien in der Behandlung der schweren Hypercholesterinämie koronarkranker Patienten: HMG-CoA-Reduktase Inhibitoren und H.E.L.P.- LDL-Apherese. Versicherungsmedizin 44:186–192PubMedGoogle Scholar
  33. 33.
    Lees RS, Holmes NN, Stadler RW et al. (1996) Treatment of hypercholesterolemia with heparin-induced extracorporeal low-density lipoprotein precipitation (HELP). J Clin Aphereses 11:132–137CrossRefGoogle Scholar
  34. 34.
    Kroon AA, Aengevaeren WRM, van der Werf T et al. (1996) LDL-Apheresis atherosclerosis regression study (LAARS). Effect of aggressive versus conventional lipid lowering treatment on coronary atherosclerosis. Circulation 93:1826–1835PubMedGoogle Scholar
  35. 35.
    Clarke R, Daly L, Robinson K et al. (1991) Hyperhomocysteinemia: an independent risk factor for vascular disease. N Engl J Med 324:1149–1155PubMedCrossRefGoogle Scholar
  36. 36.
    Alfthan G, Aro A, Gey F (1997) Plasma homocysteine and carcdiovascular disease mortality. Lancet 349:397PubMedCrossRefGoogle Scholar
  37. 37.
    Mayer EL, Jacobsen DW, Robinson K (1996) Homocysteine and coronary atherosclerosis. J Am Coll Cardiol 27:517–527PubMedCrossRefGoogle Scholar
  38. 38.
    Stabler SP, Marceli PD, Podell ER et al. (1988) Evaluation of total homocysteine in the serum of patients with cobalamin or folate deficiency detected by capillary gas chromatography - mass spectometry. J Clin Invest 81:466–474PubMedCrossRefGoogle Scholar
  39. 39.
    SOLVD Investigators (1991) Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 325:293–302CrossRefGoogle Scholar
  40. 40.
    SOLVD Investigators (1992) Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fraction. N Engl J Med 327:685–691CrossRefGoogle Scholar
  41. 41.
    CONSENSUS Trial Study Group (1987). Effects of enalapril on mortality in severe congestive heart failure: Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med 316:1429–1435CrossRefGoogle Scholar
  42. 42.
    ACC/AHA Task Force Report: Guidelines for the evaluation and management of heart failure. Circulation 92:2764–2784Google Scholar
  43. 43.
    Slatton ML, Irani WN, Hall SA et al. (1997) Does digoxin provide additional hemodynamic and autonomic benefit at higher doses in patients with mild to moderate heart failure and normal sinus rhythm? J Am Coll Cardiol 29:1206–1213PubMedCrossRefGoogle Scholar
  44. 44.
    Koefoed BG, Gullov AL, Petersen P (1997) Prevention of thromboembolic events in atrial fibrillation. Throm Haemost 78:377–381Google Scholar
  45. 45.
    First International Study of Infarct Survival (ISIS-I) Collaborative Group (1986) Randomised trial of intravenous atenolol among 16,027 cases of suspected acute myocardial infarction: ISIS-I. Lancet 57–65Google Scholar
  46. 46.
    Yancy C, Escobar J, Solomon M et al. (1997) Management of ischemic heart disease in patients reffered for cardiac transplantation. J Am Coll Cardiol 29:28AGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • O. Oldenburg
  • R. Erbel

There are no affiliations available

Personalised recommendations